Great changes are occurring in the financing of health care in America, which are in turn influencing the clinical care of individuals with sickle cell disease (SCD). One great changes has been the use of long acting antibiotics to lower the rate of admission for febrile illness in SCD. The Children's Hospital of Philadelphia has recently instituted a extended stay acute care unit to further attempt to reduce the number of hospitalizations for febrile illness in children with SCD. This project will construct a detailed cost identification model of four alternative approaches to the management of febrile illness in children with SCD. The study will consist of five tasks: (1) To conduct a cost identification study; 92) To estimate patient/family direct and indirect costs associated with a febrile episode in the hospital; (3) To pilot a revised algorithm for the management of febrile illness after analyzing two years of cost data; (4) To perform a second cost identification study using data generated under a revised febrile illness algorithm; and (5) To propose final recommendations regarding the management of febrile illness based on the economic data collected from these studies. This study will analyze results from three different perspectives: the patient/family, the hospital, and society. The project will examine equally efficacious algorithms concerning the prevention of sepsis in SCD. However, since costs to the family may influence compliance with these disease management algorithms, the results of the proposed study may have important medical as well as economic implications. There have been no detailed cost analyses of the alternative approaches to febrile illness in SCD, and especially lacking is any data on the economic impact of these alternative approaches on the family and individual patient. In an era of cost containment, this study should provide fundamental information needed to rationally manage limited resources for this chronically ill population.